Munini District HospitalMASS DESIGN GROUP

Over the past 20 years, Rwanda has undergone incredible transformation, and its healthcare sector is but one example. The nation currently has plans to build several district hospitals. Working with the Ministry of Health, MASS developed a set of design-driven principles to improve health outcomes that can be adapted to the specific needs of each district’s context, demographics and programmatic requirements. To aid the Ministry’s infrastructure team in sizing, specifying, procuring and evaluating future designs, this included Program and Design Standards and a “how-to” guide to shape future renovation and construction.

In parallel with the development of the National Standards, MASS designed a 300-bed facility in Nyaruguru, one of Rwanda’s poorest districts. The project site, typical of Rwanda’s mountainous topography, is on a hilltop marked by centuries of human history: the terraced hillside is shaped by years of agricultural production, the buildings sit atop a former colonial military control point, and at the hill’s crest, a mass grave and memorial commemorates an especially bleak chapter of the country’s history: the 1994 genocide.

To adapt the plan to a relatively tight site, the program’s three bars are bent in accordance with the natural contours of the hill, and are strategically opened up to allow prevailing winds to pass through the buildings. Given that the majority of outpatients arrive by foot or public transport, the primary entrance is a landscaped path with multiple places for open air seating to combat infection, along with green spaces for a tranquil healing environment. Emergency services are vertically separated from the reception to allow for ease of flow across the ER, operations, ICU, imaging and post-op areas—each connected by a bridge that ties the three bars to the core. Due to the frequency of power outages, the building’s vertical circulation incorporates two centrally located ramps that also serve to animate the central courtyard.

Rwanda’s equatorial climate allows for the building to be almost completely open to the surrounding environment. The hospital’s largest program elements—private rooms and open wards—are set back from the edge to provide shading as well as dedicated balconies and outdoor spaces. To prevent airborne infection, all internal hallways are removed, displacing user movement to the exterior where the risk is much lower. Working with mechanical engineers, MASS ensured adequate natural ventilation, and designed nursing stations that minimize risk to staff.
The building has a cutting-edge maternity suite, including delivery, OR, ICU, and NICU wards to assist Rwanda further reduce rates of infant and maternal mortality. These steps build upon the impressive strides the country has made in achieving those aspects of the Millennium Development Goals.

Through its work, MASS has found that one of the most under-leveraged opportunities to achieve impact through building is in redesigning the building process to foster social engagement, training and equitable hiring. At Munini, they specified brick produced within 10 km and stone quarried from the immediate region to encourage contractors and suppliers to directly engage Munini’s community.

Jury Comments

MF: There’s a finesse in the research and the materiality of this design—the building composition is solid and well-grounded. It sets new, high standards for the area.

PH: Many projects in the third world are bereft of architectural ambition—a loss for building users but also for the architects involved. This project demonstrates what can be accomplished when architects take on that responsibility. There’s consideration of how solid and void balance in the façade. The building is planned in narrow bars in a way that harnesses the microclimate of the site for ventilation.

JH: Architects have the responsibility to provide sufficient, inspiring and appropriate responses to global issues such as health. In this project, we particularly appreciated the sensitivity to the local context. There’s an understanding that with simple means, you can achieve a lot.